Clinical skills for medicine 1

Question 1

Perform a respiratory examination

Answer 1

Question 2

Perform a cardiology examination

Answer 2

Question 3

What is this condition and present? (PRO ABCDE)

Answer 3

• Right-Sided Pleural Effusion
• Key Features:
  
  • Whiteout area of the CXR.
  • Loss of all margins within the area of the effusion (i.e. not confined to lung tissue zones).
  • Meniscus can be clearly seen to the left and right of the fluid line.
• Notes:
  
  • Unilateral effusions need further investigation to determine the underlying cause.
  • Usually related to a local pathology (i.e. para-pneumonic effusion or lung cancer) rather than a systemic pathology (e.g. heart failure).

Question 4

What is this condition?

Answer 4

• Left-Sided Tension Pneumothorax
• Key Features:
  
  • Loss of lung markings around the left periphery of the lung.
  • Left lung is collapsed into a smaller space.
  • The airway and mediastinum is shifted over to the right.
• Notes:
  
  • In tension pneumothorax, mediastinum usually shifts before airway (pendulum effect).
  • If airway has started to shift then the pneumothorax is VERY BAD.
  • Management is with immediate decompression.

Question 5

What is this condition?

Answer 5

• Left-Sided Mid Zone Lung Cancer
• Key Features:
  
  • Well defined opacity within the lung field.
• Notes:
  
  • If making a true “radiological” diagnosis, we cannot say for certain that this is a malignancy.
  • Would need further 3D assessment – however we can say it is a “well circumscribed opacity which is in-keeping with malignancy”.

Question 6

What is this condition?

Answer 6

• Congestive Cardiac Failure
• Key Features:
  
  • Alveolar Oedema
  • B Lines (the straight line where the cost-diaphragmatic angle should be)
  • Cardiomegaly
  • Dilated Upper Vessels
  • Effusion (although none seen on this CXR!)

Question 7

What is this condition?

Answer 7

• Fractured Left Clavicle
• Key Features:
  
  • Clear fracture through the left clavicle with displacement.
• Notes:
  
  • Always important to look at the edges of the CXR for important diagnoses
  • Most radiologists have “check zones” to make sure they’ve looked out for these things!

Question 8

What is this condition?

Answer 8

• R Lower Zone Consolidation
• Key Features:
  
  • Area of consolidation containing air bronchograms (consistent with pneumonia).
  • No clear loss of R mediastinum boarder or R hemi-diaphragm so cannot localise clearly to R lower lobs vs R middle lobe.
• Notes:
  
  • Pneumonia is a radiological diagnosis.

Question 9

Interpret this ECG

Answer 9

Answer:

AF with fast ventricular response.

Rate: 102bpm

Rhythm: Irregularly Irregular

Axis: Normal

Question 10

Interpret this ECG

Answer 10

Answer:

Anterior STEMI.

Rate: 78bpm

Rhythm: Regular

Axis: Normal

Note: Almost 1^st degree Heart Block (PR interval ~5 small squares).

Question 11

Interpret this ECG

Answer 11

Answer:

Sinus bradycardia.

Rate: 48bpm

Rhythm: Regular

Axis: Normal

P wave, PR interval, QRS complex, QT interval, ST segment, T waves:

All normal.

Question 12

Interpret this ECG

Answer 12

Answer:

Ventricular Fibrillation

Question 13

Interpret this ECG

Answer 13

Answer:

Second Degree Heart Block: Mobitz Type I

Atrial Rate: 90

Ventricular Rate: 72

Rhythm: Regularly Irregular

Axis: Normal

Progressively lengthening PR Interval until a QRS complex is “dropped”.